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Use of time interval histographic output from echo-Doppler to detect left-to-right atrial shunts
Insights
This study shows that time interval histogram (TIH) analysis using range gated pulsed Doppler (RGPD) can effectively detect atrial level left-to-right shunts in children. The method demonstrated high accuracy and agreement between examiners, proving its usefulness in diagnosing congenital heart defects.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Medical Ultrasound
Background:
- Atrial level left-to-right shunts are common congenital heart defects.
- Accurate and objective diagnostic methods are crucial for timely intervention.
- Range gated pulsed Doppler (RGPD) offers potential for non-invasive cardiac assessment.
Purpose of the Study:
- To evaluate the effectiveness of time interval histogram (TIH) analysis from RGPD in identifying atrial level left-to-right shunts in pediatric patients.
- To assess the diagnostic accuracy and inter-observer agreement of the TIH method.
- To identify associated cardiac lesions in children with atrial shunts.
Main Methods:
- Examination of time interval histogram (TIH) output from range gated pulsed Doppler (RGPD).
- Diastolic TIH dispersion was used to differentiate children with atrial shunts from controls.
- Two independent examiners, blinded to patient diagnoses, interpreted the results.
- A pool of 57 children, including those with acyanotic cardiac disease, was studied.
Main Results:
- The TIH method correctly identified 13 out of 14 children with atrial shunts.
- One examiner detected the 14th child with an atrial shunt.
- All control children were correctly identified as negative for atrial shunts.
- High inter-observer agreement (97.7%) was achieved in 308 TIH decisions for the atrial shunt group.
Conclusions:
- Time interval histogram (TIH) evaluation using RGPD is a useful and objective method for detecting atrial level left-to-right shunts in children.
- The findings support continued investigation and technical improvements for this diagnostic approach.
- The TIH method shows promise for improving the diagnosis of congenital heart disease in pediatric populations.
Abstract:
The primary purpose of this study was to attempt to select, by examination of the time interval histogram (TIH) output of a range gated pulsed Doppler (RGPD), all children with left-to-right shunt at the atrial level from a pool of 57 children. Fifty-four of the children had various forms of acyanostic cardiac disease. A secondary purpose was to identify any associated lesions in those children with atrial defects. Examiners were unfamiliar with the children and their diagnoses. Results were interpreted independently by two examiners. Detection of diastolic TIH dispersion was used when studying the right atrial outflow tract to separate children with atrial left-to-right shunts from control children. All controls were judged negative by this technique, and 13 of 14 children with atrial shunts were detected by both examiners; the 14th was detected by one examiner. Of a total of 308 TIH decisions on the atrial shunt group, 298 were made identically by both examiners for a 97.7% agreement, demonstrating the objectivity of the method. This study demonstrated the usefulness of the TIH evaluation, indicating that continued investigation and equipment improvements are warranted.